Hi all,
I've booked up to see my CRS next Monday for a 30 minute consultation to find out exactly what is going on. I got the new fissure in early December and it isn't really clearing up. I had a rather weird bowel motion this morning. Everything shot out of me like bullets from a gun, but it wasn't diarrhoea. Fully formed but a bit explosive. I think I may have nicked the rectal wall right at the opening, to add to my existing fissure issues - oh happy day .

What I'd like to know is when I see her, I believe she can transfer me to NHS as I won't be able to afford the private treatment unfortunately. She also does NHS work and ideally I'd like to see her again through this and possibly have her operate on me. I was told by one of the GPs, that you can't specify which consultant you see or have operate on you. If true, this is a bit of blow, as she knows my history and has dealt with me for a couple of years. I also trust her. I'm worried I'd get some junior doctor with only a few months experience or a really careless surgeon. Anyone know the truth as far as what I can and can't expect to happen when I'm transferred?

As far as UK private care goes, does anyone know if it's possible to pay off a bill gradually or is it all upfront. If it's the latter, than it's unlikely I can finance it.

Incidentally, my chosen option would probably be LIS at this stage, having endured 20-odd years of rectal issues without any form of surgery (except an unrelated hernia op). I've also looked into having a colostomy, but I was told by my GP, that it's very unlikely to happen unless I had Crohns or another more serious bowel/anal/rectal issue. I just want some sort of solution and feel it needs to happen this year for the sake my and my family's sanity and happiness!

Hi banjo,
Yes most private surgeons who operate on the NHS as well, will be happy to transfer you. That is what I did. My surgeon just gave me the number of his NHS secretary and she put me on his NHS operation list...I didn't even have to have another consult just was put straight on the list.
Some private hospitals will do a payment plan but still there are a lot that don't. None near me did.
No NHS surgeon would give you a colostomy for fissures as the risk is not deemed as appropriate to the condition....I would have to fight to get one and I have crohns and IBS, plus colostomies bring their own issues too.
Good luck banjo I'm sure once you have had LIS you will be feeling back to your normal self.

Hi MPB. Nice to hear from you :)

So your CRS who you saw privately also carried out your op? I hope I have the same thing if that was the case. You remember I told you about my CRS also carrying out my hernia op and not applying enough topical anaesthetic. I'm not holding that against her and in every other regard I trust her completely. She performs the gentlest examinations I've ever had (and I've had a few!). She also exudes confidence and we get on really well (first name terms). So I'm hoping she can do this for me. She has been a bit reluctant to offer the full LIS thus far, but I'm hoping I can be more persuasive lol!

Can I ask you how long it took to get your op after the consultation? Incidentally thanks again for putting up with endless questions. How are you doing since the op? Are things starting to settle down yet?

Yes he was great...he gave me his home phone number so I could have the weekend to consider my options then he popped me on his list...his secretary was expecting my call as he had emailed her straight after I phoned him. I was waiting 6 weeks but that was for my Botox and fissurectomy.
He also made sure that he operated on me for my LIS and not one of his juniors as he knew I wanted the cut as long as possible.
I'm doing ok thanks much better than I was...I'm still getting some stinging and burning after a BM but had no spasms for about 2/3 weeks now so I'm very grateful for that. I am def improving just slowly but that's ok because we knew it would be a longer road than normal lol.
I think once you find a surgeon you trust then you stick with them because so many surgeon can be very dismissive.

It's interesting you mention about have the sphincter cut as long as possible. I can absolutely understand that. Is your reasoning that it won't have to be re-done if it's too conservative or you have a particularly tight sphincter to begin with...or both?! I feel the same way, if that is the case, with my 120 resting pressure...not good!

I just want it over with and can live with a bit of incontinence. She may suggest the Botox - I hope not as this strikes me as a temporary solution for somebody prone to years of rectal issues. I'm just keeping my fingers crossed that the outcome won't be more tinkering. I'd rather suffer for a month or two than live like this into my advancing years.

I'm glad things are getting a bit better for you. I think we all can face temporary pain and discomfort if we can see a light at the end of the tunnel.

Another problem I will probably have if I get to have the op is I work from home (indie writer/publisher) and all my work revolves around the computer. I don't own a laptop, just a couple of desktop models, so it's going to really tricky if I can't sit. Most of my work during this time can be largely admin/accounts (anything creative on the backburner lol!). But I'm guessing most of you use a laptop, even for posting on here. Minor issue, but still a problem.

My fissure was too long to cut the whole length of it so I needed it cut as long as was possible to help with the healing...lots of docs say it doesn't matter but there is research that shows if you can't cut the full length spasms can continue and I for one can confirm that....but yes my resting pressure was very high so not much chance of incontinence...and again I have had no incontinence at all and still have to force out wind.
Don't see why she would offer Botox...your male you have a high pressure unless your fissure is small or superficial then not sure why...don't get me wrong Botox gave me lots of pain free time much quicker than the LIS but for me the Botox was to attempt some healing of a very bad fissure before my LIS.
Oh wow....I couldn't sit at a computer for more than 30 mins even now certainly at the bad points 2 mins would have been too long lol...maybe invest in a laptop or netbook....or have a break for a few weeks.
Yes I don't mind the stinging and burning....don't get me wrong I would prefer not to have it...but after the hours of spasms and not being able to do much, I can now at least go out with friends and go to the gym...I feel almost normal...not being able to eat properly doesn't bother me my colon has been an issue for years now...it's the pain that ruins lives.

A laptop sounds a must - or at least something similar and portable. With the combination of the LIS healing and your Crohns problems, what do you manage to eat reasonably safely? Even now, I'm on a diet of jacket potatoes (minus skins), white fish, broccoli/peas, white bread (I'm avoiding wholemeal at the moment), fish fingers and a various fruits - mainly pears (tinned and fresh minus skins), cantaloupe melon and occasional stewed apple. I do also eat a chicken breasts, even though I probably shouldn't. This diet alone is enough for me to try anything to be able to eat properly again. I used to eat virtually anything (within reason) and looked forward to food. Now I pretty much eat as a must, rather than a pleasure.

Just wanted to pop into this conversation to suggest using a couch seat cushion on top of whatever chair you use at your desktop. After my LIS, I had to lie on my side (and wouldn't even have been able to use a laptop), but after a few days, could sit at my computer on top of a couch seat (and I mean the main cushion, not a throw or small pillow that you would use decoratively on top). This made for a very odd-looking couch (a huge 1/3 of it sitting there empty), but because of its thickness, I had no pain while sitting at my desk. DO NOT, however, use a ring pillow, because they can cause hemorrhoids. Good luck and I hope that things work out well for you soon.

Thanks CCC,

I've been using an inflatable doughnut ring on my office chair for years, albeit only partially inflated. I don't use it when I'm eating or watching the television, but I guess it's become a bit of habit because of all my rectal problem over the years. It's a bit like a crutch for my rear end lol. There seem to be two schools of thought on this. One thinks it's a seriously bad idea, as you say for causing or exacerbating piles. Whilst the other feels it lessens the pressure on a fissure or hem. To be honest, I'm not sure who is right.

On a related theme, I would have thought that there needs to be some sort of breakthrough on post operative pain management. That's as much of a key to healing as the various surgical options are and not just with rectal problems. How feasible this is I have no idea, but I do think that should be more of goal than it seems to be. I know when I had my hernia surgery, there was no getting away from the slightly sickening tugging sensation a 4-6" stitched up wound left me with. I probably should have opted for keyhole, but I had a standard incision site. Slower recovery because of it. Now if they could only supply the means for example to freeze the incision area in an LIS or anything similar, people would probably feel less anxious about the post-op situation than they are. I guess they would if they could, but it just seems a logical step forward in many areas.